Pediatric Coding Alert

Question: I read that the CPT 2008 manual doesn't contain three new vaccine codes. Would you explain this, and tell me which codes I shouldn't overlook?

Illinois Subscriber

Answer: Sometimes the AMA accepts a vaccine code, but the approval comes after the publication deadline. Therefore, the vaccine codes aren't printed in the most recently released book. To allow immediate use of the vaccines with a specific code, the AMA releases the codes online and makes them useable.

Because the codes aren't in the CPT 2008 manual, check with payers before submitting the codes.

You may need to send the insurance representative proof of the new codes. Put this in your letter: The AMA accepted codes 90650, 90681, and 90696 at the June 2007 CPT Editorial Panel meeting for the 2009 CPT production cycle. "Therefore, these codes will not appear in the 2008 CPT code book," according to information that the AMA provided on vaccine codes. But these codes are effective on Jan. 1, 2008. I have attached the AMA's notification found at http://www.ama-assn.org/ama1/pub/upload/mm/362/vaccinecodes.pdf and highlighted the pertinent section. Useable but not in print codes include:

Note: A lightening bolt, which indicates the vaccines are awaiting FDA approval, precedes these codes.

-- Answers to You Be the Coder and Reader Questions provided/reviewed by Susan Callaway, CPC, CCS-P, an independent coding auditor and trainer in North Augusta, S.C.; Frank Cohen, CMPA, CPA, of Health Partners in Clearwater, Fla.; Richard H. Tuck, MD, FAAP, a pediatrician at PrimeCare of Southeastern Ohio in Zanesville; Cyndee Weston, executive director of the American Medical Billing Association in Sulphur, Okla.